A comparison of the image quality of full-time myocardial perfusion SPECT vs wide beam reconstruction half-time and half-dose SPECT

Wide Beam Reconstruction (WBR) (UltraSPECT, Ltd) uses resolution recovery and noise modeling to cope with decreased SPECT count statistics. Because WBR processing reconstructs half the usual SPECT count statistics, we postulate that image quality equivalent to a full-time acquisition can be achieved in either half the time or with half the radiopharmaceutical activity. In 156 consecutive patients (pts) rest and 8-frame gated post-stress myocardial perfusion SPECT was performed following 333-444 and 1184-1480 MBq (9-12 and 32-40 mCi) Tc-99m sestamibi injections, respectively, with full-time (rest = 14 min; stress = 12.3 min) acquisitions processed with OSEM and also separate half-time acquisitions processed with WBR. A subsequent group of 160 consecutive pts matched in gender, weight, and chest circumference received half-dose rest and stress injections 214.6 +/- A 22.2 and 647.5 +/- A 92.5 MBq (5.8 +/- A 0.6 and 17.5 +/- A 2.5 mCi) with full-time SPECT acquisitions. Image quality (1 = poor to 5 = excellent) was judged by myocardial count density and uniformity, endocardial edge definition, perfusion defect delineation, right ventricular visualization, and background noise. Mean image quality for rest, stress, and post-stress gated images were 3.6 +/- A 0.7, 3.8 +/- A 0.7, and 3.9 +/- A 1.0, respectively, for full-time OSEM; 3.7 +/- A 0.8, 4.0 +/- A 0.7, and 4.8 +/- A 0.4 for half-time WBR; and 4.3 +/- A 0.8, 4.6 +/- A 0.6, and 4.7 +/- A 0.6 for half-dose WBR. Half-time and half-dose WBR image quality were both superior to standard full-time OSEM (P's < .001). There was no significant difference between the summed stress and rest scores for full-time OSEM vs half-time WBR in 82 patients with perfusion defects. Both half-time and half-dose WBR provide myocardial perfusion SPECT quality superior to full-time OSEM, with an associated decrease in scan acquisition time and patient radiation exposure, respectively.